Healthcare Provider Details

I. General information

NPI: 1003640947
Provider Name (Legal Business Name): DANIELLE BOLIN PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE IMEL PT,DPT

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 FORT AMANDA RD
LIMA OH
45804-3728
US

IV. Provider business mailing address

1932 SHAWNEE DR
SIDNEY OH
45365-3505
US

V. Phone/Fax

Practice location:
  • Phone: 419-999-2055
  • Fax:
Mailing address:
  • Phone: 419-790-4682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT021293
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: